Endoscopic assisted probing for symptomatic congenital nasolacrimal duct obstruction after one year of age.

PURPOSE: When probing treatment for congenital nasolacrimal duct obstruction fails, it is often unclear whether it is due to technical difficulties or the severity of obstruction. Therefore our aim was to study the causes of probing failure and how to treat them. METHOD: In a prospective study, 36 lacrimal systems of 26 children aged 12 months to 4 years with congenital nasolacrimal duct obstruction (CNLDO) were treated by probing. In all children probing was done under direct vision using nasal endoscopy. Different forms of CNLDO were treated and studied to determine the potential predictors for treatment failure. RESULTS: The overall success rate was 94.5 %. Expected failure was attributed mainly to the construction of different forms of membranous penetration on probing. Surgical membranotomy at the area of Hasner's valve under direct nasal endoscopic visualization is an essential step for proper management of CNLDO. CONCLUSIONS: Nasolacrimal duct probing under direct nasal endoscopic visualization can be considered as the standard treatment of CNLDO as it minimizes intranasal trauma and leads to a better surgical outcome.

Minimally invasive video-assisted thyroidectomy for small follicular thyroid nodules.

Minimal access surgery in the thyroid compartment has evolved considerably over the past 10 years and now takes many forms. This study examined the feasibility and reliability of minimally invasive thyroid surgery for the management of small benign thyroid lesions. A total of 68 patients with small thyroid nodules admitted to the Oncology Center of Mansoura University, Egypt, were enrolled in this prospective randomized trial. Patients were allotted to one of two procedures: minimally invasive video-assisted thyroidectomy (MIVAT) or minimally invasive open thyroidectomy using the Sofferman technique of strap muscle transection. Exclusion criteria were nodules > 4 cm, presence of thyroiditis, and thyroid gland volume > 20 ml. Preoperative diagnosis, operating time, blood loss, postoperative pain, complications, and cosmetic outcome were all evaluated. The MIVAT group included 35 patients, and the Sofferman group included 33 patients. The main preoperative pathology was a benign follicular lesion (70.5%), and the main postoperative final pathology was follicular adenoma (54.4%). The two groups were comparable regarding age, sex, and extent of thyroid surgery. Operating time was significantly longer in the MIVAT group (115.4 +/- 33.5 minutes) compared to the Sofferman group (65.6 +/- 23.7 minutes). The postoperative course was significantly less painful in the MIVAT group (p < 0.05). Although patients in the MIVAT group had smaller incisions (p < 0.05), the cosmetic outcome in the two groups was comparable. No long-term complication was encountered in either group. Two distinct approaches of minimally invasive thyroidectomy are now available and can be performed safely in selected patients. Despite some MIVAT advantages of less postoperative pain and slightly better cosmesis, minimally invasive open thyroidectomy offers an advantage of less operating time with comparable cosmetic results.